Renal artery dissection associated with Gz acceleration

A 55-yr-old male presented with flank pain and nausea minutes after intensive aerobatic flight maneuvers. An initial diagnosis of acute appendicitis was made. Computed axial tomography and renal arteriography showed a right kidney with two renal arteries, a right upper pole infarction, and a dissection in the upper renal artery which had a more vertical trajectory than the usual main renal artery. No signs of diseases known to be associated with renal artery dissection were present. The patient recovered without residual hypertension. Heavy positive G loads may have potential to cause renal arterial injury, particularly when renal vascular anatomical variations exist. The postulated mechanism is similar to fall injuries in which the subjects landed on their feet, with inertia causing caudal renal dislodgement and stretch of the renal vessels.